Both VA Benefits and Medicare provide comprehensive medical coverage for a variety of needs. However, they work in different places. If you go to a VA facility for your medical care, your VA medical benefits will apply. However, outside that system, you have to pay the full cost yourself, even in an emergency.
Full Answer
Can I Use my Medicare benefits to pay for VA care?
You can also choose to use your Medicare benefits. You pay for the fees relating to the services you received, then submit your own claim to the VA. This option takes longer, but it might prove necessary if you can’t get to a VA hospital.
Does the VA pay for Medigap?
Although the VA doesn’t bill Medicare, they may bill your Medigap plan for services the plan covers (which are the same as those Medicare covers). Do veterans lose their VA when they sign up for Medicare?
Should I sign up for Medicare if I have VA benefits?
Yes. We encourage you to sign up for Medicare as soon as you can. This is because: We don’t know if Congress will provide enough funding in future years for us to provide care for all Veterans who are signed up for VA health care. If you’re in one of the lower priority groups, you could lose your VA health care benefits in the future.
Do VA hospitals accept Medicare claims?
When You Use a VA Hospital If you get medical care at a VA hospital, your VA benefits will generally cover the costs. This is because the VA uses providers who are covered under the plan, so you won’t necessarily need the institution to submit any claims to Medicare.
How to avoid paying penalties for VA?
To avoid paying penalties, make sure you enroll in a creditable drug plan by the due date. VA medical benefits offer a creditable drug plan that might prove more cost-effective than other options, such as Medicare or TRICARE. Sometimes, paperwork gets lost or buried.
How to file a VA claim?
The process varies depending on the provider’s preferences: 1 The provider can file the claim with the VA, and you only pay any applicable deductibles. You can also choose to use your Medicare benefits. 2 You pay for the fees relating to the services you received, then submit your own claim to the VA. This option takes longer, but it might prove necessary if you can’t get to a VA hospital. 3 Use your Medicare benefits instead of your VA medical benefits. You might prefer this option if you don’t have the money to pay up front for services rendered as described in the second option.
Can you use Medicare and Medicare at the same time?
The government can suspend or lower funding at any time, and you don’t want to find yourself without viable medical coverage. Just remember that you can’t use both benefits at the same time. If you use Medicare to help pay for an MRI scan, for instance, the VA won’t pick up the rest of the cost.
Can disabled veterans live near VA hospitals?
Some disabled veterans don’t live near VA hospitals. In this case, they may receive fee-based identification cards. They can present these for treatment at a health care facility or doctor’s office. Be sure to call ahead before accepting an appointment since not all providers accept these cards.
Does Medicare cover VA hospital?
If you get medical care at a VA hospital, your VA benefits will generally cover the costs. This is because the VA uses providers who are covered under the plan, so you won’t necessarily need the institution to submit any claims to Medicare. However, Medicare can also cover services included with your VA medical benefits.
Who pays first, Medicare or Veterans Administration?
Who Pays First, Medicare, or the Veterans Administration? The simple answer to the question of who pays first is both. When you go to the Veterans facilities, the only coverage you have is Veterans Administration coverage. Then, when you go to civilian facilities, you only have Medicare coverage.
What is Medicare Advantage for veterans?
Many veterans are going to find Medicare Advantage a practical solution to coverage. Most plans boast a $0 premium and extra benefits beyond Medicare. Some plans may include prescription drug coverage. Depending on the service area, an Advantage plan could include telehealth, dental, vision, and a gym membership.
Does Medicare cover veterans?
As you know, Veteran benefits only apply to Veterans’ facilities and doctors. So, if you want to see a civilian doctor, Medicare can help with some of the costs. Having both Medicare and Veterans benefits gives you the opportunity to see a wide range of doctors and specialists. The Veterans Association recommends you enroll in Part A ...
Do disabled veterans have to have Medicare?
While it’s not mandatory, the Veterans Administration suggests all veterans, disabled or not, have Medicare. It’s especially beneficial to have Medicare when the need for civilian coverage arises. You might be thinking you’re fine without it, but delaying Part B will result in penalty charges when you do enroll.
Can you get a prescription for Part D?
Part D for Veterans. Even though you can get prescriptions through the Veterans Administration, sometimes it’s more convenient to have Part D. For example if a civilian doctor prescribes a medication, the Veterans Administration doctor needs to approve the medication for the Veterans Administration to cover. But, if you have Part D, you can go fill ...
Is Medicare creditable for veterans?
This is because the Veterans’ benefits are not considered creditable coverage under Medicare. Medicare will provide coverage outside a Veterans facility, this can come in handy in the case your Veteran benefits are dropped or if your local Veteran facility does not cover all your health services, you could pay up to 100% ...
Does VA health care meet the ACA?
If I’m signed up for the VA health care program, does that mean I meet the requirements to have health care under the Affordable Care Act (ACA)? Yes. Being signed up for VA health care meets your Affordable Care Act health coverage requirement of having “minimum essential health coverage.”.
Does VA pay deductible?
Your private insurer may apply your VA health care charges toward your annual deductible (the amount of money you pay toward your care each year before your insurance starts paying for care).
Why do you need a Medicare Supplement Plan?
Because both of these plans provide you with more coverage than Original Medicare ( Part A and B ). A Medicare Supplement plan helps fill in the gaps (deductibles, copayments, out-of-pocket expenses, etc.) left by Medicare.
Is Medicare Part B required?
Medicare Part B is optional, but there are penalty fees for signing up after the initial enrollment period. It’s important to note that Part B can help pay for care that’s not covered by your VA benefits. So, while it’s not a requirement, it is good to enroll once you qualify.
Do veterans need medicare?
So, do veterans need Medicare? No, they don’t. That said, veterans’ benefits only cover your care at VA clinics. Medicare covers you ANYWHERE that accepts Original Medicare. So, adding Medicare is a great way to save on costs and have more choices with your health insurance. For even more coverage, savings, and flexibility, you can add a Medicare Supplement or switch to Medicare Advantage.
Does Medicare cover VA hospital?
For example, when you go to a VA hospital, your VA benefits will cover it (Medicare will not). When you go to a non-VA hospital in your network, your Medicare plan will cover it (VA benefits usually won’t).
Does Medicare Advantage cover Part B?
With a Medicare Supplement plan, you have access to any doctor who accepts Medicare. Medigap also covers most costs associated with seeing your doctor, including Part B copayments, Part B premiums, and excess charges.
Do VA benefits work together?
This leaves many veterans wondering how (or if) Medicare and VA benefits can work together to provide them with the healthcare they need. Moreover, if you already get VA health benefits, you may want to know if you should buy a Medicare Supplement (Medigap) plan.
Is Medicare primary or non VA?
If you go to VA clinic or hospital, your VA benefits will be your primary. Alternatively, if you go to a non-VA clinic, Medicare will be your primary.
Why do veterans use VA benefits?
Some use VA benefits as to avoid the gaps in Medicare and the costs they would incur. On the flip side, there are also many Veterans who recognize that those gaps can be covered through Medicare Supplement insurance.
How to contact VA insurance?
This is often best done through an independent insurance agent who has access to multiple insurance companies and their rates. Please call me (1-888-411-1329) if you have any questions about your VA benefits and Medicare Supplement. I look forward to speaking with you.
How does Medigap work?
Medigap plans come with a monthly premium that you pay to the insurance company. As a Medicare recipient, you are entitled to find a lower premium for the same Medigap Plan at anytime throughout the year. This is often best done through an independent insurance agent who has access to multiple insurance companies and their rates. ...
Is Medicare and VA separate?
Medicare and the VA are separate. Quite simply, Medicare and VA are separate entities. VA facilities are not Medicare approved providers. Beneficiaries usually use their VA benefits when they need help with health care items not approved by Medicare ( hearing aids, over-the-counter medications ). Medicare Supplement ( Medigap) ...
Is Medicare a back up option for VA?
Perhaps you have a conveniently located VA hospital, but it’s quality of care is not the highest compared to other hospitals in your area. Medicare is a back up option, but it still has gaps in coverage.
Do you have to be a VA to receive Medicare?
For Medicare coverage, you must receive care at a Medicare approved facility. For VA coverage, you must generally receive health care services at a VA facility.
Can you use a Medigap Plan with VA?
There are many types of Medigap Plans; but, they all help to pay for medical expenses not covered by Original Medicare…such as coinsurance and deductibles. If you have Medicare Part A and B (Original Medicare), you may want to consider supplementing with a Medigap Plan and not relying exclusively on VA benefits or Original Medicare.
Why do veterans want to sign up for Medicare?
Why Veterans May Want to Sign Up for Medicare. Funding for VA Health Care is not guaranteed. The Department of Veterans Affairs submits a budget to the federal government every year, but there is no guarantee that the requested dollar amount will be appropriated. A lower budget could mean reduced coverage or loss of coverage altogether ...
How many veterans are in Medicare?
Why Sign Up for Medicare. Of the more than 19.5 million veterans alive today, 9.1 million are currently enrolled in VA Health Care. 1 The majority of those enrollees are also eligible for Medicare.
Why did the VA scandal break out?
A scandal broke out in 2014 due to long wait times at a number of VA sites. This led to the development of the Veterans Choice Program. When appointments were not available for 30 days or more at a local VA facility, veterans could seek care with a private non-VA physician.
What are the benefits of VA?
Hearing and vision coverage is offered to veterans with the following: 2 1 Compensable service-related disability 2 Functional or cognitive impairment that decreases the ability to perform activities of daily living 3 Permanent homebound status 4 Prisoner of War 5 Purple Heart 6 Service-related hearing disability with a loss of communication ability 7 Title 38 United States Code (U.S.C.) 1151 benefits 8 Vision and/or hearing impairment related to a condition managed at the VA (e.g., cataracts, diabetes, stroke) 9 Vision and/or hearing impairment that interferes with the veteran’s medical treatment
Is Medicare Part D good?
Medicare Part D. VA prescription drug coverage is seen as creditable, i.e., as good as Medicare. For this reason, you would not face late penalties if you signed up for a Medicare Part D plan at a later time. Still, there could be benefits to enrolling in a Part D plan.
Does Medicare cover out of network VA?
Since the VA does not pay for care received out of network (unless it is part of the Veterans Community Care Program), Medicare could be a good option to cover you in an emergency or if you wanted to see certain non-VA physicians.
Does Medicare Advantage cover hearing and vision?
Some Medicare Advantage plans could offer coverage for these services as a supplemental benefit, but that could require higher monthly premiums. VA Health Care, however, does offer these services, but not to everyone. Hearing and vision coverage is offered to veterans with the following: 2.
What happens if you don't qualify for enhanced eligibility?
If you don't qualify for enhanced eligibility status, but you agree to pay copays for your care, you don't have to provide your financial information. But if you don't, we may decline your enrollment. We also won't be able to consider your eligibility for free medications or beneficiary travel pay. If you served in combat after ...
Do you have to provide income information to qualify for free care related to your exposure?
If you were exposed to Agent Orange in or near Vietnam, ionizing radiation in certain service locations or jobs, or environmental contaminants in the Persian Gulf, you don't have to provide your income information to qualify for free care related to your exposure.
Do you have to pay a VA copay?
You may need to pay a fixed amount for some types of care, tests, and medications you receive from a VA health care provider or an approved community health care provider to treat conditions not related to your service. This is called a copay (short for "copayment"). Whether or not you'll need to pay copays—and how much you'll pay—depends on your ...
When can veterans enroll in Medicare?
Like other Americans, veterans become eligible for Medicare at age 65. (Those with a qualifying disability may enroll earlier.) The best time to sign up is during your initial enrollment period. That begins 3 months before the first day of your birthday month and lasts for 7 months.
Do you have to enroll in Medicare if you have VA benefits?
You don’t. But without Medicare coverage, you’ll be uninsured for any treatment you get at non-VA facilities or care from providers not authorized in advance by the VA. You’ll be billed for the full cost of those services, at serious risk to your net worth. That’s why the VA recommends that veterans sign up for Medicare as soon as they can.
What are the benefits of combining Medicare and VA benefits?
Enrolling in Medicare could fill in gaps in the coverage you get through the VA benefits. That’s because you’ll be able to go either to VA facilities for treatment (covered under VA benefits) or to Medicare-approved doctors and facilities (covered by Medicare). Also, VA benefits are not guaranteed, so your coverage could change in the future.
Which areas of Medicare coverage and VA benefits can you combine?
Medicare and VA benefits do not work together. But they can sometimes complement each other. For example, if the VA pre-authorizes treatment at a non-VA hospital but not certain services you get during the hospital stay, Medicare may pay for those services. For specifics, contact your Medicare plan.
How does VA disability affect Medicare?
VA benefits — including disability payments — don’t affect Medicare. At age 65, you are eligible for Medicare regardless. Before that, you may receive Social Security Disability Insurance (SSDI) while you’re on VA disability. After 2 years of SSDI payments, you can enroll in Medicare. Your VA disability benefits remain in place.
What do you have to do to manage Medicare and VA benefits?
You will have to pay the premiums for Medicare Part B or Medicare Advantage as well as any cost-sharing copayments. For VA benefits, there typically aren’t enrollment fees, monthly premiums, or deductibles. But some veterans may have copayments for healthcare or prescription drugs.
Where can you get help coordinating Medicare and VA benefits?
Various government-supported offices have staffers to help you combine and manage your health plans: